A rare cause of a congenital duodenal obstruction in the newborn period with nonbilious vomiting: Annular pancreas (original) (raw)
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Feeding Intolerance and Vomiting Caused by Duodenal Pancreatic Heterotopia in a Neonate
The Journal of Pediatric Research, 2016
ABS TRACT Öz Pancreatic heterotopia (PH) is a congenital abnormality defined by the presence of an ectopic pancreatic tissue outside the usual anatomic location of the pancreas. The frequency of the disorder is reported to be 0.2-15% in autopsies, 1-2% in laparotomies. The most common locations are the stomach, duodenum and jejunum. The symptoms develop as per the localization particularly in the elderly. We presented a term neonate with a birth weight of 4460 gr hospitalized due to bilious vomiting 10 days after birth. The neonate presented 17% of dehydration, jaundice, and hypochloremic alkalosis on admission. Upper gastrointestinal contrast study demonstrated delayed passage. A mass of lace appearance in the second part of the duodenum was observed by endoscopy and was surgically excised. The diagnosis of PH was made through histopathological analysis. We want to highlight that although relatively rare, PH should be considered in the differential diagnosis of neonates with vomiting and feeding intolerance. The mass must be excised, if the symptoms develop.
Congenital Duodenal Obstruction in Neonates: Over 13 Years’ Experience from a Single Centre
Journal of Neonatal Surgery, 2016
Aim: To study the prevalence of associated anomalies with neonatal duodenal obstruction and factors impacting short-term survival.Material and methods: Records of 31 neonates with neonatal duodenal obstruction could be retrieved and analyzed for a 13.5-year-period (October 2003-May 2016). M:F ratio was 1.58:1. The mean birth weight was 2.15 kg; 12 patients were preterm. Etiologies included duodenal atresia (n=23), duodenal web (n=8) and malrotation of gut (n= 6).Results: Associated anomalies were seen in 19/31: Down’s syndrome (n=6), anorectal malformation (ARM) (n=5), annular pancreas (n=5), cardiac anomalies (n=4), esophageal atresia with trachea-esophageal fistula (EA with TEF) (n=3). Mortality in the series was 22.5%; 5 deaths and 2 patients left against medical advice in moribund state (hidden mortality). Mortality in associated anomalies group was 5/19; and 2/12 in the no anomalies group, though this difference was not statistically significant (p=0.676). Similarly, low birth ...
Journal of LIberia Medical and Dental Association, 2017
Background: Annular pancreas is one of the rarest causes of acute duodenal obstruction in neonates. The exact prevalence of annular pancreas is unclear as many individuals with annular pancreas are asymptomatic. We present a 7-day old male neonate who presented with non-bilious effortless coffee-ground vomitus from birth. He passed meconium with no subsequent motion of stool for 6days. Her radiograph showed a double bubble sign. He was diagnosed with a neonatal duodenal obstruction. Objective: To highlight the challenges in the diagnosis of neonatal duodenal obstruction. Materials and methods: The study is a case report of Annular Pancreas causing duodenal obstruction. The chart was retrieved and reviewed for the patient’s age, sex, clinical presentation, diagnosis and treatment. A search was conducted on the MEDLINE database for all applicable research; clinical reviews, retrospective studies and case reports. Results: The patient underwent duodeno-duodenostomy for an annular pancreas and the postoperative course was uneventful. Conclusion: Annular Pancreas is a rare disease in neonates causing duodenal obstruction. Imaging is supportive, but the diagnosis is confirmed by laparotomy. Duodeno-duodenostomy remains a viable operative option in neonates, Recommendation: A high index of suspicion is required by clinicians for diagnosis to avoid complications of delayed surgery.
Annular Pancreas in Neonates; Case Series and Review of Literatures
Background: The annular pancreas is a rare congenital disorder of the pancreas first recognized in 1818. It is believed to result from faulty rotation of the ventral pancreatic bud in its course around the posterior aspect of the duodenal anlage. The duodenum is encircled and might be obstructed by normal pancreatic tissue. The management of the annular pancreas is still developing and under revision. Case Presentation: Six cases of neonatal intestinal obstruction secondary to the annular pancreas diagnosed, operated on, and involved in our study. Age, gender, maturity, age at referral, birth weight, clinical presentation, imaging findings, associated congenital anomalies, treatment, complications, and hospital stay were all studied. Polyhydramnios is found in 3 cases (50%). Down syndrome was diagnosed in one case. One patient has associated malrotation. Symptoms started earlier within the first 24 hours. Vomiting was bile stained in 4 cases (66.7%). Passing meconium, sometimes frequent, does not exclude the annular pancreas. Most patients show double bubbles sign on plain abdominal X-ray. All six neonates were treated with duodenoduodenostomy with excellent results. Survival was 100% and complications were minimum. Conclusion: The annular pancreas, although rare, is an important cause of neonatal duodenal obstruction. The accurate diagnosis is usually performed during laparotomy. Vomiting may contain bile or not, furthermore, passing meconium does not exclude this condition. The best and the excellent surgical option is diamond duodenoduodenostomy. This case series might be added to the registered cases of the annular pancreas to standardize the method of diagnosis and to define the best management.
Congenital Short Bowel Syndrome With Annular Pancreas Presenting as Neonatal Intestinal Obstruction
Cureus
Congenital short bowel syndrome (CSBS) is a very rare gastrointestinal anomaly of unknown etiology. We report a case of a six-week-old male with CSBS who presented with features of intestinal obstruction and failure to thrive. The abdominal radiograph was suggestive of a central gasless abdomen, and a provisional diagnosis of malrotation of the gut with volvulus was considered. On exploration, the duodenum was hugely dilated with annular pancreas, which was not obstructing the duodenum. The length of the intestine was 20 cm from the duodenojejunal junction to the ileocecal junction. Duodenal web was ruled out. Total parenteral nutrition (TNP) was started postoperatively. Early and long-term parenteral nutrition and referral to specialist centers with intestinal rehabilitation programs have improved the overall outcome; however, the challenges are entirely different in developing countries.
Annular pancreas with duodenal stenosis and intestinal malrotation in two years girl: A case report
Paediatrics Today, 2014
Objective -To describe a rare case of a combination of annular pancreas with malrotation in early childhood. Case report -The patient is 2 year old aged girl with persistent non-bilious vomiting. She was vomiting several times a week, and over the ten days prior to presentation as many as several times a day. Upon presentation, the patient had an unremarkable abdominal exam with no abdominal pain. An upper gastrointestinal study showed extreme dilatation of the stomach and the duodenal bulb, and an abdominal computer tomography scan revealed an annular pancreas. Intra-operatively we find an annular pancreas and treated it by duodeno-duodenostomy, while the intestinal malrotation was treated by Ladd's procedure. Conclusion -Annular pancreas is a rare congenital anomaly which in childhood is related to duodenal atresia or stenosis and often affiliated with intestinal malrotation.
International Surgery, 2016
Purpose: In infants, the duodenum is the most frequently obstructed region of the gastrointestinal tract. The objective of the present study was to summarise the causes of early mortality and morbidity in infants with congenital duodenal obstruction (CDO). Methods: Data on a total of 94 patients with CDO diagnosed in our clinic, and treated surgically between January 1993 and December 2012, were studied retrospectively. Patients were divided into three groups in terms of diagnosis: annular pancreas (n = 45), duodenal atresia (n = 31), and duodenal web (n = 18). The groups were compared in terms of sex, birth weight, age at the time of operation, and morbidity and mortality rates. Results: Of the patients, 54 were males and 40 females, and the mean birth weight was 2,278 (range, 1,180-3,400) g. The average age at the time of the operation was 6.96 (range 1-38) days. The time to full oral intake postoperatively was 10.32 (range, 4-38) days. Additional anomalies were found in 61 (64.8%...
Annular pancreas in children: A recent decade’s experience
Journal of Pediatric Surgery, 2004
Purpose: Annular pancreas is a recognized cause of duodenal obstruction in children. The authors sought to characterize the clinical, radiologic, and prognostic findings in this disorder through a 10-year review of all patients with annular pancreas.
Duodenal obstruction in an infant a rare presentation
A four and half month old female baby was admitted in our hospital with history of curdy white vomits and fever of seven days duration after normal delivery in a hospital . The parents of the infant observed peristaltic movements from left to right two months after delivery. The baby was kept on breast feeds which was followed by vomiting after each feed, the baby started having forceful projectile vomits after two months resulting in dehydration and passage of small hard stools. Clinical examination revealed an emaciated baby with tachycardia (HR 150/mt), good cry and no evidence of visible peristalsis after feeds. No lump could be palpated in epigastrium. CT abdomen was suggestive of duodenal stenosis resulting in dilatation of stomach. Gastrograffin studies revealed hugely dilated stomach and first part of duodenum. Exploration revealed a hugely dilated stomach and first part of duodenum which was compressed by an extra luminal tight thick band extending from pancreas to porta hepatis. Underneath this thick band intraluminal obstruction of first part of duodenum was found due to severe stenosis and obliteration by a diaphragm. Baby underwent duodeno-duodenal anastomosis after excision of extra luminal obstructing band with uneventful and exceptionally excellent post-operative recovery.